Profile of HIV-1 RNA viral load among HIV-TB co-infected patients in a tertiary health facility in Maiduguri, Northeastern Nigeria

Abstract

The overlapping epidemiology of human immunodeficiency virus (HIV) infection and tuberculosis (TB) is expected in Nigeria that is ranked 10^th amongst the 22 countries that bears the burden of TB worldwide. This study aims to estimate the HIV-1 RNA viral load and impact of anti TB therapy (ATT) in a CD4 cell count matched HIV/TB co- infected and HIV infected patients. Records of 159 cohorts were randomly retrieved from a database of 15,012 patients receiving care at Harvard PEPFAR clinic, UMTH from September (2004-2014). Participants consisted of 78 HIV-TB co-infected, and 81 HIV infected patients without TB with similar CD4 cell count. Baseline mean CD4 count between the two group was similar (P=0.118). HIV-TB co infected patients had a higher baseline median ± SD (95%CI) HIV-1 RNA viral load (copies/ml) of 198,480 ± 615, 051 (52,899-344,060) than HIV positive patients without TB that had 20, 772 ± 105, 484 (2,703-44, 246), p<0.001. The reduction in mean HIV-1 RNA level was unremarkable after 6 months in response to ART/ATT among HIV/TB co-infected patients (GI), P =0.200. HIV infected patients without TB (GII) had significant reduction in mean HIV-1 RNA level p= 0.002, after 6 months of ART/ATT. Both group had a significant increase in CD 4 cell count level; it was however, more profound in GII than GI, P <0.001. HIV/TB co-infection is associated with higher HIV-1 RNA viral load among HIV patients after controlling for level of immunity. The higher HIV-1 viral load associated with active TB persists after six months of ART/ATT. We recommend timely commencement of ATT in HIV/TB co-infected patients especially in sub Saharan Africa with dearth of facility for viral load estimation.

Keywords: anti-tubercular therapy, antiretroviral therapy, HIV/TB co-infection